Die Patientenperspektive jenseits ambulant-stationärer Sektorengrenzen – Was ist Patientinnen und Patienten in der sektorenübergreifenden Versorgung wichtig?

Ludt, Sabine; Heiss, Friederike; Glassen, Katharina; Noest, Stefan; Klingenberg, Anja; Ose, Dominik; Szécsényi, Joachim

doi:10.1055/s-0033-1348226

Cited by 17 publications

(16 citation statements)

References 11 publications

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“…This probably reflects a “real life scenario” with respect to the care that multimorbid patients actually receive in Germany, as it is generally criticized for being fragmented and event-driven [7,9,40]. Wensing et al reported a similar mean score (2.3) in patients with COPD that had been treated in rural general practices in the Netherlands, but many other studies showed higher scores, with mean scores of 2.7 or 2.8 in samples of patients with cardiovascular disease [21,41], and scores of above 3 in patients with depression [42].…”

Section: Discussionmentioning

confidence: 99%

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

Petersen

Paulitsch

Mergenthal

et al. 2014

BMC Health Serv Res

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BackgroundIn primary care, patients with multiple chronic conditions are the rule rather than the exception. The Chronic Care Model (CCM) is an evidence-based framework for improving chronic illness care, but little is known about the extent to which it has been implemented in routine primary care. The aim of this study was to describe how multimorbid older patients assess the routine chronic care they receive in primary care practices in Germany, and to explore the extent to which factors at both the practice and patient level determine their views.MethodsThis cross-sectional study used baseline data from an observational cohort study involving 158 general practitioners (GP) and 3189 multimorbid patients. Standardized questionnaires were employed to collect data, and the Patient Assessment of Chronic Illness Care (PACIC) questionnaire used to assess the quality of care received. Multilevel hierarchical modeling was used to identify any existing association between the dependent variable, PACIC, and independent variables at the patient level (socio-economic factors, weighted count of chronic conditions, instrumental activities of daily living, health-related quality of life, graded chronic pain, no. of contacts with GP, existence of a disease management program (DMP) disease, self-efficacy, and social support) and the practice level (age and sex of GP, years in current practice, size and type of practice).ResultsThe overall mean PACIC score was 2.4 (SD 0.8), with the mean subscale scores ranging from 2.0 (SD 1.0, subscale goal setting/tailoring) to 3.5 (SD 0.7, delivery system design). At the patient level, higher PACIC scores were associated with a DMP disease, more frequent GP contacts, higher social support, and higher autonomy of past occupation. At the practice level, solo practices were associated with higher PACIC values than other types of practice.ConclusionsThis study shows that from the perspective of multimorbid patients receiving care in German primary care practices, the implementation of structured care and counseling could be improved, particularly by helping patients set specific goals, coordinating care, and arranging follow-up contacts. Studies evaluating chronic care should take into consideration that a patient’s assessment is associated not only with practice-level factors, but also with individual, patient-level factors.Trial registrationCurrent Controlled Trials ISRCTN89818205.

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Section: Discussionmentioning

confidence: 99%

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

Petersen

Paulitsch

Mergenthal

et al. 2014

BMC Health Serv Res

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“…Dies führt im ambulanten Bereich zu einem beträchtlichen nachstationären Versorgungsaufwand [7]. Patientenseitig werden daher gerade im Kontext von Multi morbidität besonders die defizitäre nachstationäre Unterstützung, Widersprüchlichkeiten verschiedener fachärztlicher Informationen sowie unklare Verantwortlichkeiten an der Schnittstelle beanstandet [9]. Ein zentraler Fokus sollte auf der pharmakotherapeutischen Weiterbehandlung des Patienten sowohl am Übergang vom Krankenhaus in den ambulanten Sektor als auch umgekehrt liegen.…”

Section: Stationär -Ambulant-hausärztliche Schnittstelleunclassified

“…Ein zentraler Fokus sollte auf der pharmakotherapeutischen Weiterbehandlung des Patienten sowohl am Übergang vom Krankenhaus in den ambulanten Sektor als auch umgekehrt liegen. Studien belegen, dass eine kontinuierliche Weiterführung von bestehenden Medikationen in diesen Transferbereichen derzeit nicht immer sicher gegeben ist [9][10][11][12][13][14][15]. Eine Studie aus dem Jahr 2010 konnte an der Schnittstelle zwischen stationärer und ambulanter Behandlung offenlegen, dass zahlreiche, subjektiv wahrgenommene und strukturelle Probleme existieren.…”

Section: Stationär -Ambulant-hausärztliche Schnittstelleunclassified

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„Da kann man sich ja totklingeln, geht ja keiner ran“ – Schnittstellenprobleme zwischen stationärer, hausärztlicher und ambulant-fachspezialisierter Patientenversorgung aus Sicht Dresdner Hausärzte

et al. 2018

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There are several problems with all adjacent interfaces. What is striking here is the lack of communication and cooperation between all parties involved. Possible causes were the often very different working methods and framework conditions, human and material resources and therapeutic intentions and approaches between the different interfaces. One possible approach to improve the situation may be the law regarding secure digital communications and healthcare applications, which exists since 2016. Among other things, it promises a secure and rapid inter- and intrasectoral exchange of patient data. The overall goal of healthcare in Germany should be an optimized and process-oriented interface management in order to ensure a secure and seamless sectoral transition to patients.

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“…Patients are known to be clear definers of good quality, good evaluators of the healthcare they receive and good rapporteurs of their experiences with healthcare (Donabedian, 1992). Patients' views are crucial for judging patient-relevant outcomes and they are often the only tie between different healthcare sectors and services (Blum et al 2001;Ludt et al 2014).…”

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confidence: 99%

Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness

Bramesfeld

Stegbauer²

2016

Epidemiol Psychiatr Sci

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The World Health Organisation has defined health service responsiveness as one of the key-objectives of health systems. Health service responsiveness relates to the ability to respond to service users’ legitimate expectations on non-medical issues when coming into contact with the services of a healthcare system. It is defined by the areas showing respect for persons and patient orientation. Health service responsiveness is particularly relevant to mental health services, due to the specific vulnerability of mental health patients but also because it matches what mental health patients consider as good quality of care as well as their priorities when seeking healthcare. As (mental) health service responsiveness applies equally to all concerned services it would be suitable as a universal indicator for the quality of services’ performance. However, performance monitoring programs in mental healthcare rarely assess health service performance with respect to meeting patient priorities. This is in part due of patient priorities as an outcome being underrepresented in studies that evaluate service provision. The lack of studies using patient priorities as outcomes transmits into evidence based guidelines and subsequently, into underrepresentation of patient priorities in performance monitoring. Possible ways out of this situation include more intervention studies using patient priorities as outcome, considering evidence from qualitative studies in guideline development and developing performance monitoring programs along the patient pathway and on key-points of relevance for service quality from a patient perspective.

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Die Patientenperspektive jenseits ambulant-stationärer Sektorengrenzen – Was ist Patientinnen und Patienten in der sektorenübergreifenden Versorgung wichtig?

Abstract: Patients' experiences provide important information to identify quality gaps along the entire chain of care. Study results can be used to develop a cross-sectoral patient-centred quality assessment instrument.

Cited by 17 publications

References 11 publications

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

Implementation of chronic illness care in German primary care practices – how do multimorbid older patients view routine care? A cross-sectional study using multilevel hierarchical modeling

„Da kann man sich ja totklingeln, geht ja keiner ran“ – Schnittstellenprobleme zwischen stationärer, hausärztlicher und ambulant-fachspezialisierter Patientenversorgung aus Sicht Dresdner Hausärzte

Assessing the performance of mental health service facilities for meeting patient priorities and health service responsiveness

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